Lecture 1: Principles of EM (enochs) Flashcards
What 3 things can be given in practically any undifferentiated situation?
- Dextrose
- Narcan
- Thiamine
what are the 8 steps of determining care in an ER
- is the patient about to die?
- what must be done to stabilize them?
- what are the diseases/dx most likely to cause this presentation?
- could there be multiple causes?
- can tx assist in the diagnosis?
- is diagnosis mandatory/possible?
- do they need admission?
- if not, is disposition safe and adequate for the patient?
what is the difference between a critical patient, an emergent patient and a nonemergent patient
critical = needs life saving attention
emergent = illness/injury may progress if treatment is not initiated soon
Nonurgent = low chance of rapid progression
What is the other reason to admit a patient other than them having a serious condition?
They need to be able to f/u outpatient on their own adequately.
AKA do they have sufficient resources to manage at home?
What is EMTALA?
- Emergency Medical Treatment and Labor Act
- Duty to provide emergency care (stabilize patients)
- prior to EMTALA hospitals could refuse to provide emergency care to pts when tx would result in little/no payment
Who does EMTALA apply to?
Any facility that has a medicare contract
Pretty much all hospitals in the US.
When does EMTALA no longer apply?
- Patient is now in stable condition and they admit/transfer patient elsewhere
- Patient’s emergent condition is ruled out
What is the duty of a receiving hospital when receiving a transfer?
If the receiver has the capabilities to currently treat and there is no closer facility.
Cannot deny based on insurance.
Only way to deny would be to lack the specialty or lack beds.
what information is included in informed consent
- pts diagnosis
- purpose of treatment
- risks and expected outcome of tx
- alternative treatments and their risk
- consequence of no treatment
What are the exceptions to informed consent?
- Medical emergencies with inability to communicate
- no one is available to make decisions
- no time to obtain consent
- Recurrent tx (dialysis)
- Pt waives their right to be informed
- Doctrine of therapeutic privilege
The doctrine of therapeutic privilege is invoked when there is a serious concern that full disclosure of a procedure might cause serious emotional or physical harm.
Who obtains informed consent?
Person ordering/doing the procedure
How long do we hold an opioid OD post narcan admin before they can leave?
1-1.5 hours to wait out half-life of narcan.
Opioid prob lasts longer, so they can undergo resp depression after
How does informed consent vary for an adult Jehovah’s witness pt vs a minor?
- Adult can refuse tx even if life-threatening.
- If minor, involve hospital legal counsel, as a parent cannot refuse life-saving tx for a minor.
what are the aspects that MUST BE INCLUDED in medical records
- patient identifiers (age/gender/race/ID)
- time/means of arrival
- appropriate vitals
- pertinent H&P findings
- Allergies/reactions
- medications
*diagnostics and results - emergent care given prior to arrival
- ER course
- details of procedures
- medical decision making (Diff diagnosis)
- diagnostic impression
- final disposition (where and who)
- pt condition on DC/transfer
- doc of DC instructions
I feel like she could ask “all of the following except….. MUST BE included in medical records” so maybe just be familiar
when applicable, medical records SHOULD include what additional information?
